Couples Therapy to be Tested as Treatment for Major Depression

Winston-Salem, N.C. – Treating a couple together and not just an individual partner might be a better therapy for that individual’s depression, say researchers at Wake Forest University Baptist Medical Center.

They soon will test whether a combination of “couples therapy” and antidepressants works better than antidepressants alone when the wife has major depression.

Wayne H. Denton, M.D., Ph.D., said he will be adapting couples therapy as a treatment for depression, using information he gains through a preliminary study. Couples therapy is used elsewhere in psychiatry, but will be a new method for treating depression. He said he would train and supervise four licensed marriage and family therapists to provide the treatment.

Participating patients and their husbands will be randomly assigned either to the couples therapy plus the antidepressant sertraline (Zoloft) or to sertraline alone.

“Depression is a serious public health problem,” said Denton, associate professor of psychiatry and behavioral medicine.

About 17 percent of the population will develop major depression sometime in their lifetimes, and 70 percent of those will have recurrences. At least half of the people who commit suicide suffer from major depression.

While antidepressants generally are effective treatment for major depression under most circumstances, some patients don’t respond at all or relapse. “There is a need for improved treatments,” Denton said.

He said he would be seeking 56 couples to participate in the clinical trial, beginning in July. The clinical trial will require 15 one-hour treatment sessions for each couple conducted by the marriage and family therapists, and several additional meetings with Denton.

“As depression research has become more sophisticated, we’re asking additional questions – not just are the patients feeling better, but are they feeling well,” Denton said. “A lot of patients don’t yet feel well. They still are depressed but less depressed.”

To develop the couples therapy for depression, he said he would “interview couples about their experience in living with major depression.” He’ll conduct separate diagnostic interviews with each partner. “Often when one partner is depressed, the other will suffer as well.”

Denton’s interviews are not intended to be therapeutic and are not part of the clinical trial, “but a lot of people find that telling their story is therapeutic.” He said he wants to understand “their experience living with depression and how it has affected their relationship with their spouse, good or bad, and what has been helpful to them as a couple in dealing with depression.”

What he learns from the preliminary work will be incorporated in the treatment manual for couples therapy of depression, and will be used for developing a competence scale for therapists who administer couples therapy and for training materials for the clinical trial.

The preliminary study will involve interviews with 10 to15 couples over the next several months.

The study is being funded as part of a $831,177 grant from the National Institutes of Health. The Zoloft is being provided by Pfizer, Inc., the manufacturer.

Denton’s study is one of several studies of major depression within the Department of Psychiatry and Behavioral Medicine. Peter Rosenquist, M.D., is testing transcranial magnetic stimulation as an alternative, while Vaughn McCall, M.D., is determining whether quality of life in severely depressed patients improves more following electroconvulsive therapy -- shock treatment -- than it does in patients treated with antidepressants.

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